Equipment Options for Safe Patient Handling - A Hands On Approach 58 th Annual Governor’s Industrial Safety & Health Conference October 7-8, 2009.

Equipment Options for Safe Patient Handling

- A Hands On Approach

58th Annual Governor’s Industrial Safety & Health Conference

October 7-8, 2009

2

Presenters

• Jeannette Murphy, OTR/L, CEA– Ergonomist, Injury Prevention Specialist– St. Luke’s Rehabilitation, Spokane WA

• Leslie Pickett, PT– Ergonomics and Injury Prevention Specialist– Swedish Medical Center, Seattle WA

• Lynn LaSalle, MOT– Ergonomist, Ergonomic Coordinator– MultiCare Health System (MHS), Tacoma WA

3

Participants will…

• Understand how to choose the right equipment for the right patient at the right time

• Understand some of the challenges and solutions for safe patient handling of the bariatric patient

• Understand the different levels of patient handling equipment and what to consider when choosing equipment

• Have the opportunity to handle and use common safe patient handling equipment.

4

Why Safe Patient Handling?

• Protect staff and patients– It’s the “right thing” to do

• Enable experienced health care professionals to work longer– It’s the necessary thing to do.

• Comply with Washington’s Safe Patient Handling Law– It’s the law!

5

NACs

RNs

6

NACs

7

Washington StateSafe Patient Handling Law

• March 8, 2006 – Signed into law• Goal – Reduce injuries among patients and

health care workers by manually lifting, moving and repositioning patients.

• “Safe Patient Handling” – The use of engineering controls, lifting and transfer aids or assistive devices by staff instead of manually lifting to perform the acts of lifting, transferring and repositioning patients.

8

Washington State Safe Patient Handling Law

• Components– Committee – develop by February 1, 2007– Program – develop by December 1, 2007– Equipment – minimum purchase by January 30, 2010– Employees’ Right to Refuse Policy – develop by

January 2010– Tax Credits – Must be claimed before December 30,

2010– L&I Lower Risk Classification for hospitals with SPH

programs– Program Evaluation required

9

Who is included in this law?

All 97 of the hospitals in Washington State, including public district hospitals, private nor-for-profit and for-profit hospitals, and three state hospitals for the mentally ill.

What does the law require hospitals to do?

By February 1, 2007 – all hospitals must establish a Safe Patient Handling Committee with at least half of the Committees members be frontline non-managerial employees who provide direct care to patients. The purpose of the Committee is to design and recommend the process for the implementing a Safe Patient Handling Program.

By December 1, 2007 – all hospitals must establish a Safe Patient Handling Program. The program must include:

Implementing a safe patient handling policy for all hospital units and shifts; Conducting a patient handling hazard assessment, which should consider patient-handling tasks,

types of nursing units, patient populations, and patient care areas; Develop a process to identify the appropriate use of the safe patient handling policy based on the

patient’s physical and medical condition and the availability of lifting equipment or lift teams; Conduct an annual performance evaluation to determine the effectiveness in reducing

musculoskeletal disorder claims and related lost work days, and to make recommendations for improvement;

Consider the feasibility of incorporating patient handling equipment or the physical space needed to incorporate it when developing architectural plans.

By January 30, 2010 – all hospitals must complete, at a minimum, the acquisition of their choice of (1) one lift per acute care unit on the same floor unless the Committee determines that a lift is unnecessary, (2) one lift for every 10 acute care available inpatient beds, or (3) equipment for use by lift teams.

What type of training must the hospitals provide?

Hospitals are required to train staff on policies, equipment, and devices at least annually.

How is “safe patient handling” defined?

It means the use of engineering controls, lifting and transfer aids, or assistive devices, by lift teams or other staff, instead of manual lifting to perform the acts of lifting, transferring, and repositioning of patients.

What happens if nurses don’t follow the procedure for safe patient handling?

Hospitals shall develop procedures for hospital employees to refuse to perform or be involved in patient handling that the employee believes in good faith will expose a patient or the employee to an unacceptable risk of injury. Any employee who in good faith follows the procedure shall not be subject to disciplinary action by the hospital for refusing to perform or be involved in the patient handling or movement.

What incentives are provided to hospitals to acquire the necessary equipment?

The law provides for a tax credit of up to one thousand dollars for each acute care available inpatient bed towards the cost of purchasing mechanical lifting devises and other equipment that are primary used to minimize patient handling by health care providers.

Who will enforce this law?

The Department of Health will have oversight of the non-State hospitals implementation of the law while Department of Social and Health Services will oversee the State owned facilities.

The Department of Revenue will handle the tax credit for the acquisition of equipment. The Department of Labor & Industries will develop rules to provide a reduced workers’ compensation

premium for hospitals that implement a safe patient handling program.

Frequently Asked Questions Regarding WA State Safe Patient Handling Law

10

Guidelines for Choosing Equipment

• The right equipment for the right patient at the right time– Patient centered– Assess patient each and every time he/she is moved– Use equipment when needing to lift more than 35 lbs

of the patient’s weight – Use least restrictive equipment to allow patient to help

• The patient will only be safe when the health care worker is safe

11

Equipment Options

• High tech– Dependent

• Low Tech– More ability

• Total patients lifts• Sit-to-stand lifts• Hovermatt• Hoverjack• Glide/slide sheets• Transfer boards/slides• Pivot discs• Sheet as hip sling

Walking belts• Gait belts

12

Assessment of the Patient’s Transfer and Mobility Status

1. Level of assistance – What the pt does, not how much you do for them

2. Weight bearing capability

3. Upper extremity strength

4. Balance

5. Level of cooperation and comprehension

6. Weight/height

7. Precautions/modifiers affecting transfers

13

1 – Level of Assistance Functional Independence Measures

(FIMTM)7. Complete independence No setup, cues or touching

6. Modified independence Adaptive equipment, longer time needed, safety considerations

5. Standby assistance/supervision Set-up, cues, coaxing, within one arm’s reach of patient

4. Minimal assistance/contact guard Pt does 75% or more, any touching

3. Moderate assistance Pt does 50-74% of work, more help than touching, any lifting

2. Maximal assistance Pt does 25-49% of work

1. Total assistance/dependent Pt does <25% of work, automatically a total assist with 2 people assisting

14

2 – Weight-Bearing Capability

• Bridging – test hip and leg strength

Not acceptable

15

2 – Weight-Bearing Capability

• Straight leg raising

Not acceptable

• Straight leg raising – test hip and leg strength

16

3 – Upper Extremity Strength

• Observe if/how the patient uses arm(s) for …– Bed mobility– Come to sitting– Support self when sitting– Wheelchair mobility– Feeding– Grooming– Bathing– Toileting

17

4 – Balance

• Can the pt sit on the side of the bed without support?

• Can the pt sit forward in the chair without help?

Not acceptable

18

5 – Cooperation and Comprehension

• If the pt cannot follow verbal instruction/gestures to bridge, straight leg raise, or demonstrate good balance…– DO NOT MANUALLY TRANSFER– Use a mechanical lift or assistive device

19

6 – Weight/Height

• Is the pt’s weight/height within the limits of the equipment?

• If more than 35 lbs. is being lifted during a manual transfer, then lift equipment, transfer aids or assistive devices should be used instead.

20

7 – Precautions/Modifiers

• Does pt have any behaviors or characteristics that make transfers inconsistent or especially difficult – Pusher, leaner, impulsive, unpredictable, excessive

tone, contractures, fear of falling– Bariatrics

• If so, lift equipment should be used.